Mycoplasma infection of the urinary and reproductive system

　　I. Treatment

　　1. Non-surgical treatment

　　(1) Chemical cauterization: phenol or trichloroacetic acid can be locally applied to corrode the tumor mass.

　　(2) Treatment methods such as liquid nitrogen freezing, electrocoagulation, or laser can be used.

　　(3) Traditional Chinese medicine external therapy: apply Wumiao Shuxian cream, Jingshui cream, or痣膏to the affected area until it falls off.

　　(4) Larger skin lesions can be treated with electro-drying under local anesthesia.

　　2. Surgical excision

　　Large pedunculated lesions can be surgically excised at the root. Most cases do not require anesthesia, and the base is cut off, and if there is bleeding, it can be stopped externally with aluminum chloride.

　　II. Prognosis

　　Infants may have conical protuberances around the anal area, which can regress over time and generally do not require treatment.

　　1. It can cause urethritis, male infertility, chronic prostatitis, epididymitis, salpingitis, pelvic inflammatory disease, vaginitis, and other conditions. Ureaplasma urealyticum is one of the important pathogenic organisms causing perinatal maternal and child infection.

　　2. Ureaplasma urealyticum infection in pregnant women, infertility, spontaneous abortion, fetal death, etc.

　　3. Perinatal infection (Ureaplasma urealyticum) can cause stillbirth, miscarriage, preterm birth, low birth weight, and other conditions. Survivors mainly present with:

　　(1) Neonatal pneumonia: it can have an acute, persistent, and chronic process. The symptoms vary in severity. Most cases are subclinical or mild, with no clinical symptoms or only mild respiratory distress. There are no rales or only a small amount of fine moist rales in the lungs. The chest X-ray shows small areas of shadow or thickened textures. A few severe cases may die due to respiratory failure.

　　(2) Neonatal meningitis: clinical manifestations vary in severity. Mild cases may have no symptoms or only mild to moderate fever, slightly poor feeding response, irritability, etc. The cerebrospinal fluid routine is normal or slightly abnormal, and the Mycoplasma culture is positive. The course of the disease is self-limiting with no sequelae. Severe cases are more common in premature infants or very low birth weight infants, with clinical manifestations such as seizures or severe depression. The cerebrospinal fluid routine shows an increase in cell count and an increase in the ratio of neutrophils or lymphocytes. Severe cases may be complicated by intraventricular hemorrhage, ventricular enlargement, or hydrocephalus.

　　(3) Septicemia: It has a low incidence and atypical clinical symptoms, manifested only by refusal to take milk, less crying, poor response, and other non-specific symptoms.

　　What are the typical symptoms of mycoplasma infection in the urinary and reproductive systems1. Non-gonococcal urethritis (NGU):

　　There is urgency, frequency, urinary burning, dysuria, and the appearance of secretions in the urethra. There is swelling of the external urethral orifice, and there may be tenderness along the urethra. There is a large number of red and white blood cells in the urine; the smear examination of urethral secretions does not show gonococci.2. Pelvic inflammatory disease:

　　Most patients have acute or subacute salpingitis, with lower abdominal pain, chills, and fever; lower abdominal tenderness, marked tenderness, and pain in the adnexal area; increased white blood cell count, and when acute pelvic adnexal peritonitis occurs, there are masses in the pelvis and marked tenderness.3. Vaginitis and cervicitis:

　　Vaginal discharge increases, vulvar itching; vaginal and cervical mucosa are congested.4. Mycoplasma disease in pregnant women:

　　5. Other: Uteritis, infertility, spontaneous abortion, fetal death, etc.It can also cause chronic prostatitis, epididymitis, male infertility, and other conditions.

　　6. Perinatal infection (Ureaplasma urealyticum):It can cause stillbirth, fetal death, miscarriage, preterm birth, low birth weight infants, and survivors mainly manifest as

　　(1) Neonatal pneumonia: It can have an acute, chronic, or persistent course, with varying degrees of symptoms. Most cases are subclinical or mild, with no clinical symptoms or only mild respiratory distress, without rales or a small amount of fine moist rales in the lungs. Chest X-ray shows small areas of shadowing or coarse lines. A few severe cases may die due to respiratory failure.

　　(2) Neonatal meningitis: The clinical manifestations vary in severity, with mild cases showing no symptoms or only mild to moderate fever, poor suckling response, irritability, etc. The cerebrospinal fluid is normal or slightly abnormal, and the culture of mycoplasma is positive. The course is self-limiting with no sequelae. Severe cases are more common in preterm infants or very low birth weight infants, with clinical manifestations including seizures or severe depression, increased white blood cell count in the cerebrospinal fluid, and an increased proportion of neutrophils or lymphocytes. In severe cases, intraventricular hemorrhage or ventriculomegaly, hydrocephalus may occur.

　　(3) Septicemia: It has a low incidence and atypical clinical symptoms, manifested only by refusal to take milk, less crying, poor response, and other non-specific symptoms.

　　1. Sources of infection: patients and carriers.

　　2. The modes of transmission generally involve contact, especially sexual contact. The transmission routes of Ureaplasma urealyticum during the perinatal period include vertical transmission from mother to child (intrauterine and birth canal) and horizontal or iatrogenic transmission after delivery. Vertical transmission accounts for 18% to 55%, and it increases with the incidence of parasitism in the maternal reproductive tract and chorioamnionitis. Preterm infants and very low birth weight infants are more susceptible than full-term infants. Intrauterine infection routes include ascending infection of amniotic fluid and fetus from the cervix and vagina. Hematogenous infection is transmitted from the mother to the fetus through the placenta. Since the female lower genital tract is the main residence of Ureaplasma urealyticum, neonates may become infected during vaginal delivery. A few neonates have negative urine cultures at birth, but become positive at 2 and 4 weeks, indicating the existence of horizontal or iatrogenic transmission.

　　3. Susceptibility to the population Humans are generally susceptible to mycoplasmas, with a higher infection rate in promiscuous populations. Additionally, Ureaplasma urealyticum and Mycoplasma hominis have a high detection rate in non-promiscuous populations, especially in pregnant women. Therefore, mycoplasmas are likely to be opportunistic pathogens residing in the lower urogenital tract.

　　4. Epidemiological characteristics It is present worldwide, but the incidence seems to be related to the sexual chaos of men and women in the region. Etiology: Among 15 human mycoplasmas, 7 are more common in the urogenital tract. Briefly introduce Mycoplasma genitalium and Ureaplasma urealyticum:

　　(1) Mycoplasma genitalium has a flask-shaped appearance, with a height of 0.6-0.7μm, a bottom width of 0.3-0.4μm, a top width of 0.06-0.08μm, and an end with a rod-like structure. It does not grow on general culture media but grows on SP-4 medium without thallium acetate. The optimal growth temperature is 37°C. It can ferment glucose but cannot hydrolyze arginine or urea. Mycoplasma genitalium grows very slowly and grows faster during subculture. It cannot grow in liquid culture or under aerobic conditions. After growth, the culture medium appears granular and slightly turbid. In an environment containing 5% CO2 and N2, this mycoplasma can grow on solid culture media, forming 'frying egg'-like colonies. The size of the colonies is extremely inconsistent, with a diameter of 20-200μm, and can be inhibited by erythromycin and other antibiotics. It can adhere to glass, plastic, and epithelial cell surfaces, invade and enter epithelial cells, and has the ability to slide and adsorb human and animal red blood cells. Its genome is 600Kbp, making it the smallest genome among all mycoplasmas. Its adhesion structure (MGPa) is 1.4×105 membrane proteins.

　　(2) Ureaplasma urealyticum, formerly known as T-mycoplasmas, belongs to the genus Ureaplasma of the family Mycoplasmataceae. It has 12 serotypes and is divided into two major groups, A and B. It is the smallest free-living prokaryotic microorganism that can reproduce in a cell-free culture medium. In liquid culture medium, it is mainly spherical, with a diameter of about 50-300nm, arranged singly or in pairs. It can pass through a 0.45μm microporous filter membrane, is Gram-negative without a cell wall, but is not easy to stain, and has a purple-blue color under Giemsa staining, which is different from other mycoplasmas. Its biological characteristics include the presence of urease, which can decompose urea to produce ammonia and CO2, causing the phenol red culture medium to change from yellow to red. It can grow on artificial culture media but has high nutritional requirements and needs cholesterol yeast and urea. It has three cell membranes, with the outer and inner layers composed of proteins, and the middle layer's lipid antigenicity mainly comes from the cell membrane and the lipid part of the urease. Urease is its specific antigen, which can act as an immunogen to induce specific antibodies (IgM). It contains ribosomes and double-stranded DNA. Due to the lack of a cell wall, it is easily dissolved by lipid solvents, ethanol, detergents, specific antibodies, and complement.

　　What kind of laboratory tests need to be done for urinary and reproductive system mycoplasma infection

　　1. Specimen collection

　　The laboratory diagnosis of mycoplasma includes culture, specific antibody detection, metabolic inhibition test, DNA probe, and PCR technology, among which culture is the most reliable, and PCR technology is the most sensitive.

　　2. Isolation culture

　　According to the different gender and lesion site of the patient, collect different specimens under sterile conditions, and inoculate them immediately into liquid culture media. When the color of the liquid culture medium changes, it is transferred to solid culture media.

　　3. Specific antibody detection

　　Some patients with reproductive mycoplasma infection can detect antibodies, but the sensitivity is not high, and the repeatability is poor, and it has not been used in clinical practice. ELISA method can detect the IgM and IgG antibodies of Ureaplasma urealyticum, which is more sensitive and specific, and has early diagnostic significance.

　　4. DNA probe technology

　　This method is sensitive, but due to the need for isotopes, it is difficult to popularize and apply.

　　5. PCR technology

　　Due to its high sensitivity and specificity, it has now moved from the experimental research stage to the clinical application stage, and has gradually become an important means of rapid clinical diagnosis.

　　6. Endoscopic examination

　　It can directly observe the inflammatory changes of the urinary and reproductive system.

　　First, dietetic therapy for urinary and reproductive system mycoplasma infection

　　1. Astragalus and Mugwort Root Drink

　　Formula: Raw Astragalus 30 grams, white mugwort root 30 grams, Cistanche deserticola 20 grams, watermelon rind 60 grams.

　　Preparation: Wash the following four ingredients and place them in a pot, add an appropriate amount of water, and boil into a concentrated juice. Add an appropriate amount of sugar to taste.

　　Effect: Beneficial to the spleen and warm the kidney, diuretic and promoting urination.

　　Usage: Take 1 dose a day, divided into 2 servings.

　　2. Millet Porridge

　　Formula: 100 grams of millet.

　　Preparation: Cook millet with water and eat it as porridge.

　　Effect: Beneficial to the spleen and kidney, and diuretic and diaphoretic.

　　Usage: Take it as breakfast and dinner, and can be taken continuously for 1-2 months.

　　3. Lotus Honey Drink

　　Formula: Fresh lotus juice 100 milliliters, white honey 30 milliliters, and raw rehmannia juice 60 milliliters.

　　Preparation: Mix the above three juices together and simmer over low heat for 10-15 minutes.

　　Effect: Nourish yin and clear heat, cool blood and stop bleeding.

　　Usage: Take 4 times a day, 10 milliliters each time, take it slowly, and take it for 3 days consecutively.

　　Second, what is good for urinary and reproductive system mycoplasma infection

　　1. Pay attention to nutrition in diet, eat more light foods such as vegetables and fruits, and supplement necessary vitamins and trace elements, such as eating more cucumbers, bitter melon, and purslane.

　　2. Eat more cooling foods. Such as mung bean, cool and detoxify. Luffa, cool blood and detoxify.

　　2. Eat more vegetables such as shepherd's purse,螺蛳, needlefish, loach, crucian carp, chrysanthemum, rapeseed, taro, mung bean, adzuki bean, Malan tou.

　　3. Eat more foods that enhance immunity: turtle, tortoise, sea turtle, sandworm, grass carp, shark, water snake, shrimp, white flower snake, crucian carp, mulberry, fig, lychee, walnut, loquat, horse-tail grass, soybean paste, olive, almond, luffa.

　　Thirdly, the best foods to avoid for urogenital mycoplasma infection

　　1. Try to avoid strong alcohol, including beer, because drinking can affect the absorption of drugs.

　　2. Try to avoid spicy food as much as possible, such as spicy food, which can stimulate local vascular edema.

　　3. Avoid fatty, fried, moldy, and salted food.

　　Firstly, the treatment method of urogenital mycoplasma infection in Western medicine

　　1. General treatment

　　Contact isolation, disinfection of articles, symptomatic treatment should be adopted according to circumstances when there are serious symptoms.

　　2. Antimicrobial drug treatment

　　First choice of erythromycin, adults 1.5g/d; children 30-50mg/(kg/d); neonates 25-40mg/(kg/d); taken orally in 3 doses, course of treatment 7-14 days. Tetracycline and lincomycin-resistant strains are increasing, and they are basically not used. In addition, josamycin, doxycycline, spiramycin, gentamicin and quinolone antibacterial drugs can be selected.

　　Secondly, the treatment method of traditional Chinese medicine for urogenital mycoplasma infection

　　1. Codonopsis pilosula 30g, Bupleurum chinense 30g, Pueraria lobata 30g, Polemonium 30g, Astragalus 30g, Poria cocos 60g, Liquorice 30g, Moschus 10g.

　　2. Astragalus 24g, Bupleurum chinense 16g, Poria cocos 16g, Gastrodia elata 10g, Schisandra chinensis 8g.

　　3. Ephedra 4g, Mentha haplocalyx 4g, Liquorice 4g, almond kernel 10g, Morus alba 10g, Platycodon grandiflorus 10g, Forsythia 10g, Chrysanthemum 8g.

　　4. Raw Astragalus 24g, Apium 10g, Schizonepeta 10g, almond kernel 10g, Platycodon grandiflorus 10g, Bupleurum chinense 10g, Scutellaria baicalensis 10g, Ephedra 6g, Liquorice 6g.

　　2. Astragalus 10g, Platycodon grandiflorus 10g, reed stem 10g, almond kernel 10g, loquat seed 10g, walnut kernel 10g, Cistanche deserticola 10g, bamboo sap 2 pieces, Lycium barbarum 12g.